Renal

The nurse is providing care for a patient after a kidney biopsy. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Check vital signs every 4 hours for 24 hours. 2. Remind the patient about strict bed rest for 2 to 6 hours. 3. Reposition the patient by log-rolling with supporting backroll. 4. Measure and record urine output. 5. Assess the dressing site for bleeding and check complete blood count results. 6. Teach the patient

1, 2, 3, 4 1. Check vital signs every 4 hours for 24 hours. 2. Remind the patient about strict bed rest for 2 to 6 hours. 3. Reposition the patient by log-rolling with supporting backroll. 4. Measure and record urine output. Rationale: Checking vital signs, repositioning patients, and recording intake and output are within the scope of practice for a UAP. Assessing and teaching are more within the scope of practice for professional nurses. If no bleeding occurs, the patient can resume general activities after 24 hours. However, instruct him or her to avoid lifting heavy objects, exercising, and performing other strenuous activities for 1 to 2 weeks after the biopsy procedure. Driving may also be restricted.

Prior to discharging a client with end-stage cancer of the bladder from the hospital, what should the nurse do? Select all that apply. 1. Determine if the client is likely to become suicidal. 2. Give a list of the client's medications to the client before discharge. 3. Instruct the client to update information when medications are discontinued, doses are changed, or new medications are added. 4. Explain the need to carry medication information with the client at all times. 5. Instruct the client that the use of over-the-counter products need not be reported to the health care provider (HCP).

1, 2, 3, 4 1. Determine if the client is likely to become suicidal. 2. Give a list of the client's medications to the client before discharge. 3. Instruct the client to update information when medications are discontinued, doses are changed, or new medications are added. 4. Explain the need to carry medication information with the client at all times. Rationale: To ensure client safety, the nurse should assess clients that might be at risk for suicide, such as those with end-stage cancer. The nurse should also communicate accurate medication information by explaining the importance of managing medication information to the client when he/she is discharged from the hospital or at the end of an outpatient encounter. Examples include instructing the client to give a list of medications to his/her HCP to update the information when medications are discontinued, doses are changed, or new medications including over-the-counter products are added; and to carry medication information at all time in the event of emergency situations.

A client has been admitted with acute renal failure. What should the nurse do while admitting the client? Select all that apply. 1. Elevate the head of the bed 30 to 45 degrees. 2. Take vital signs. 3. Establish an IV access site. 4. Call the admitting health care provider (HCP) for prescriptions. 5. Contact the hemodialysis unit.

1, 2, 3, 4 1. Elevate the head of the bed 30 to 45 degrees. 2. Take vital signs. 3. Establish an IV access site. 4. Call the admitting health care provider (HCP) for prescriptions. Rationale: Elevation of the head of the bed will promote ease of breathing. Respiratory manifestations of acute renal failure include shortness of breath, orthopnea, crackles, and the potential for pulmonary edema. Therefore, priority is placed on the vital signs because the pulse and respirations will be elevated. Establishing a site for IV therapy will become important because fluids will be administered IV in addition to orally. The HCP will need to be contacted for further prescriptions; there is no need to contact the hemodialysis unit.

A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The health care provider has prescribed 2 units of packed red blood cells (RBCs). What should the nurse determine prior to initiating the blood transfusion? Select all that apply. 1. There is an IV access with the appropriate tubing and normal saline as the priming solution. 2. There is a signed informed consent for transfusion therapy. 3. Blood typing and cross-matching are documented in the medical record. 4. The vital signs have been taken and documented in accordance with facility policy and procedure. 5. There is a second unit of blood in the medication room. 6. The client has an identification bracelet.

1, 2, 3, 4, 6 1. There is an IV access with the appropriate tubing and normal saline as the priming solution. 2. There is a signed informed consent for transfusion therapy. 3. Blood typing and cross-matching are documented in the medical record. 4. The vital signs have been taken and documented in accordance with facility policy and procedure. 6. The client has an identification bracelet. Rationale: Before prescribing and administering packed RBCs, the nurse should assess the IV site to make sure it has an 18G to 20G infusion set. The nurse should also ensure that normal saline solution is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent for the procedure by signing the consent form. The client's blood must be typed to determine ABO blood typing and Rh factor and ensure that the client receives compatible blood. Cross-matching is done to detect the presence of recipient antibodies to the donor's minor antigens. Vital signs provide a baseline reference for continuous monitoring throughout the transfusion. An identification bracelet and red blood cell band are essential for client identification per facility policy. Two nurses must double-check the client's identification with the client listed on the unit of the RBCs. The transfusion should be started within 30 minutes of the time that the RBC unit is checked out of the blood bank. Thus, no blood should be kept in the medication room before transfusion.

The nurse is teaching a patient how best to prevent renal trauma after an injury that required a left nephrectomy. Which points would the nurse include in the teaching plan? Select all that apply. 1. Always wear a seat belt. 2. Avoid contact sports. 3. Practice safe walking habits. 4. Wear protective clothing if you participate in contact sports. 5. Use caution when riding a bicycle. 6. Always avoid use of drugs that may damage the kidney.

1, 2, 3, 5 1. Always wear a seat belt. 2. Avoid contact sports. 3. Practice safe walking habits. 5. Use caution when riding a bicycle. Rationale: A patient with only one kidney should avoid all contact sports and high-risk activities to protect the remaining kidney from injury and preserve kidney function. Protective clothing may not be enough to protect the patient's remaining kidney. Drugs that may cause kidney damage may still be prescribed, especially to save a patient's life. All of the other points are key to preventing renal trauma.

The client performs self-peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that apply. 1. Broad-spectrum antibiotics may be administered to prevent infection. 2. Antibiotics may be added to the dialysis solution to treat peritonitis. 3. Clean technique is permissible for prevention of peritonitis. 4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5. Peritonitis is the most common and serious complication of peritoneal dialysis.

1, 2, 4, 5 1. Broad-spectrum antibiotics may be administered to prevent infection. 2. Antibiotics may be added to the dialysis solution to treat peritonitis. 4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5. Peritonitis is the most common and serious complication of peritoneal dialysis. Rationale: Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

The RN supervising a senior nursing student us discussing methods for preventing acute kidney injury (AKI). Which points would the RN be sure to include in this discussion? Select all that apply. 1. Encourage patients to avoid dehydration by drinking adequate fluids. 2. Instruct patients to drink extra fluids during periods of strenuous exercise. 3. Immediately report a urine output of less than 2 mL/kg/hr. 4. Record intake and output and weigh patients daily. 5. Question any prescriptions for 6. Monitor laboratory values that reflect kidney function.

1, 2, 4, 6 1. Encourage patients to avoid dehydration by drinking adequate fluids. 2. Instruct patients to drink extra fluids during periods of strenuous exercise. 4. Record intake and output and weigh patients daily. 6. Monitor laboratory values that reflect kidney function. Rationale: Dehydration reduces perfusion and can lead to AKI. Patients should be encouraged to take in adequate fluids, and extra fluids should be taken in during strenuous exercise. Intake and output, as well as daily weights, should be documented. The health care provider should be notified for a urine output of less than 0.5 mL/kg/hr that persists for more than 2 hours. Many drugs are potentially nephrotoxic but are still administered. Patients are encouraged to take in extra fluids, and nurses must monitor for any nephrotoxic effects when these drugs are prescribed.

The nurse is providing care for a patient with acute kidney failure for whom volume overload has been identified. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Measuring and recording vital sign values every 4 hours 2. Weighing the patient every morning using a standing scale 3. Administering furosemide 40 mg orally twice a day 4. Reminding the patient to save all urine for intake and output measurement 5. Assessing breath sounds 6. Ensuring that the patient's urinal is within reach

1, 2, 4, 6 1. Measuring and recording vital signs every 4 hours 2. Weighing the patient every morning using a standing scale 4. Reminding the patient to save all urine for intake and output measurement 6. Ensuring that the patient's urinal is within reach Rationale: Administering oral medications is appropriate to the scope of practice for an LPN/LVN or RN. Assessing breath sounds requires additional education and skill development and is most appropriately within the scope of practice of an RN, but it may be part of the observation of an experienced and competent LPN/LVN. All other actions are within the educational preparation and scope of practice of an experienced UAP.

A nurse is planning care for a client who underwent a percutaneous needle biopsy of the kidney. What should the nurse plan to do immediately after the biopsy? Select all that apply. 1. Assess the biopsy site. 2. Take vital signs every hour. 3. Assess urine for hematuria. 4. Place the client in a prone position. 5. Assess the client for chest pain.

1, 3, 4 1. Assess the biopsy site. 3. Assess urine for hematuria. 4. Place the client in a prone position. Rationale: The nurse should assess the biopsy site for bleeding and hematoma formation. The client should remain prone for 8 to 24 hours after the biopsy. A pressure dressing will aid in blood coagulation. Vital signs assessment should be taken every 5 to 15 minutes for the first hour and then less often if the client is stable. The urine does not need to be collected and kept on ice. The nurse should collect serial urine specimens to assess for hematuria. A renal biopsy does not put the client at increased risk for chest pain.

The RN is supervising a senior nursing student who is caring for a 78-year-old patient scheduled for an intravenous pyelography test. What information would the RN be sure to stress about this procedure to the nursing student? 1. "After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults." 2. "The purpose of this procedure is to measure kidney size." 3. "Because this procedure assesses kidney function, there is no need for a bowel prep.

1. "After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults." Rationale: The risk for contrast-induced kidney failure is greatest in patients who are older or dehydrated. If possible, arrange for the patient to have this procedure early in the day to prevent dehydration. The purpose of this procedure is to assess kidney function and identify anomalies. The administration of drugs that affect the gag reflex is not done during this procedure.

The nurse is providing education to a 22-year-old patient with diabetic neuropathy. The patient expresses the belief that since they are young and have two kidneys, sticking to their insulin schedule will prevent kidney damage. What is the BEST response the nurse should give? 1. "Despite following your insulin schedule, the risk of kidney damage remains a concern." 2. "You should consult with your physician; statistics suggest your viewpoint may be too optimistic."

1. "Despite following your insulin schedule, the risk of kidney damage remains a concern." Rationale: Diabetic nephropathy is a serious complication of diabetes that affects the kidneys. While managing blood sugar levels through insulin is crucial, it's not the only factor that contributes to kidney health. High blood pressure, high cholesterol, and even the duration of diabetes can also contribute to kidney damage. Therefore, a comprehensive approach that includes blood sugar control, blood pressure management, and regular monitoring of kidney function is essential.

An unlicensed assistive personnel (UAP) reports to the RN that a patient with acute kidney failure had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks the nurse how this can happen. What is the nurse's BEST response? 1. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." 2. "There must be some sort of error. Someone must have failed to record the urine output."

1. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." Rationale: During the oliguric phase of acute kidney failure, a patient's urine output is greatly reduced. Fluid boluses and diuretics do not work well. This phase usually lasts from 8 to 15 days. Although there are occasionally omissions in recording intake and output, this is probably not the cause of the patient's decreased urine output. Retention of sodium and water is the rationale for giving furosemide, not the reason that it is ineffective. Nitrogenous wastes build up as a result of the kidney's inability to perform their elimination function.

A patient on the medical-surgical unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) as soon as possible. What is the PRIORITY collaborative action at this time? 1. Call the charge nurse and arrange to transfer the patient to the intensive care unit. 2. Develop a teaching plan for the patient that focuses on CAVH. 3. Assist the patient with morning bath and mouth care before transfer. 4. Notify the health care provider (HCP) that the patient's mean arteria

1. Call the charge nurse and arrange to transfer the patient to the intensive care unit. Rationale: CAVH is a continuous renal replacement therapy that is prescribed for patients with kidney failure who are critically ill and do not tolerate the rapid shifts in fluids and electrolytes that are associated with hemodialysis. A teaching plan is not urgent at this time. A patient must have a mean arterial pressure (MAP) of at least 60 mmHg or more for CAVH to be of use. The HCP should be notified about this patient's MAP; it is a priority but not the highest priority. When a patient urgently needs a procedure, morning care does not take priority and may be deferred until later in the day.

The nurse is admitting a patient with nephrotic syndrome. Which assessment finding supports this diagnosis? 1. Edema formation 2. Hypotension 3. Increased urine output 4. Flank pain

1. Edema formation Rationale: The underlying pathophysiology of nephrotic syndrome involves increased glomerular permeability, which allows larger molecules to pass through the membrane into the urine and be removed from the blood. This process causes massive loss of protein, edema formation, and decreased serum albumin levels. Key features include hypertension and renal insufficiency (decreased urine output) related to concurrent renal vein thrombosis, which may be a cause or an effect of nephrotic syndrome. Flank pain is seen in patients with acute pyelonephritis.

The nurse warms the dialysis solution before use in peritoneal dialysis. What is the expected outcome of warming the solution? 1. Encourage the removal of serum urea. 2. Force potassium back into the cells. 3. Add extra warmth to the body. 4. Promote abdominal muscle relaxation.

1. Encourage the removal of serum urea. Rationale: The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

The nurse is taking care of a patient who has been diagnosed with end-stage renal disease. What should be the priority nursing diagnosis for this patient? 1. Excess fluid volume 2. Experience of pain 3. Deficit in patient knowledge 4. Intolerance to physical activity

1. Excess fluid volume Rationale: End-stage renal disease is a condition where the kidneys have lost most of their ability to function effectively. One of the primary roles of the kidneys is to filter waste and excess fluids, including electrolytes like sodium and potassium, from the blood. When the kidneys fail to perform this function adequately, it leads to fluid and electrolyte imbalances, most notably excess fluid volume. This can result in edema, hypertension, and even heart failure if not managed appropriately. Therefore, the priority nursing diagnosis for a patient with ESRD should be "excess fluid volume".

While attending to a patient who is currently in the oliguric phase of renal failure, the nurse wonders what level of 24-hour urine output she should expect to be below for this patient. 1. Less than 400 mL 2. Below 200 mL 3. Under 800 mL 4. Not exceeding 1000 mL

1. Less than 400 mL Rationale: The oliguric phase of renal failure is characterized by a significant reduction in urine output. In this phase, the kidneys are unable to adequately filter waste products and excess fluid from the blood, leading to a decrease in urine production. A 24-hour urine output of less than 400 mL is generally considered to be indicative of the oliguric phase. This low output can lead to fluid overload, electrolyte imbalances, and the accumulation of waste products in the body, all of which are serious concerns that require immediate medical attention.

The nurse is reviewing the care plan for a patient with chronic renal failure who is complaining about persistent itching or pruritus. What instruction should the nurse include in the patient's teaching plan to manage this symptom? 1. Maintain short, clean fingernails. 2. Vigorously rub the affected skin areas with a towel. 3. Utilize alcohol-based emollients for skin moisture. 4. Take baths frequently to keep the skin clean.

1. Maintain short, clean fingernails. Rationale: Persistent itching or pruritus is a common symptom in patients with chronic renal failure. The itching is often due to the accumulation of uremic toxins, dry skin, and sometimes elevated levels of phosphorus. One of the best ways to manage this symptom is to maintain short, clean fingernails. Long or dirty nails can harbor bacteria and increase the risk of skin infections when scratching. Short, clean nails minimize the this risk and also reduce the potential for skin trauma, which can exacerbate the itching and lead to further complications like infection or scarring.

The nurse is caring for a patient who has just been wheeled back from the OR following a repair of an abdominal aortic aneurysm. She's vigilant for signs of potential complications, particularly acute renal failure. What symptom should alert the nurse to the possibility of acute renal failure in this postoperative patient? 1. Oliguria 2. Nausea and vomiting 3. Complete absence of urine 4. Frequent bowel movements

1. Oliguria Rationale: Oliguria, or the production of an abnormally small amount of urine, is a classic early sign of acute renal failure. In the context of a patient who has just undergone repair of an abdominal aortic aneurysm, oliguria could indicate that the kidneys are not receiving adequate blood flow or that they have been damaged during surgery. Either way, it's a red flag that should prompt immediate intervention

The nurse is attending to a 30-year-old patient who is undergoing hemodialysis treatment. The patient has an internal arteriovenous fistula in her arm for vascular access. The nurse wants to take measurements to minimize the risk of complications related to this vascular access device? 1. Refrain from measuring blood pressure on the arm containing the arteriovenous fistula. 2. Establish intravenous lines proximal to the location of the arteriovenous fistula.

1. Refrain from measuring blood pressure on the arm containing the arteriovenous fistula. Rationale: An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, commonly used for hemodialysis. One of the key measures to prevent complications related to an AV fistula is to avoid measuring blood pressure on the arm that contains the fistula. Taking blood pressure on that arm can compress the fistula and potentially lead to clot formation or stenosis (narrowing) of the vessel. This can compromise the effectiveness of the dialysis and may even lead to more serious complications requiring surgical intervention.

The patient is receiving IV piggyback doses of gentamicin every 12 hours. Which would be the nurse's PRIORITY for monitoring during the period that the patient is receiving this drug? 1. Serum creatinine and blood urea nitrogen levels 2. Patient weight every morning 3. Intake and output every shift 4. Temperature

1. Serum creatinine and blood urea nitrogen Rationale: Gentamicin can be highly a nephrotoxic substance. The nurse would monitor creatinine and blood urea nitrogen levels for elevations indicating possible nephrotoxicity. All of the other measures are important but are not specific to gentamicin therapy.

The nurse is caring for a patient with renal failure and has order to administer Polystyrene sulfonate (Kayexalate). She understands that this medication has a specific role in managing the complications associated with renal failure. What is the primary purpose of using Polyestrene sulfonate in patients with renal failure? 1. To swap potassium ions for sodium ions. 2. To counteract constipation resulting from sorbitol usage. 3. To rectify acid-base imbalances. 4. To lower elevated serum phosph

1. To swap potassium ions for sodium ions. Rationale: Polystyrene sulfonate (Kayexalate) is primarily used to treat hyperkalemia, which is an elevated level of potassium in the blood. In patient with renal failure, the kidneys are unable to effectively excrete potassium, leading to dangerous levels that can cause cardiac arrhythmias. Kayexalate works by exchanging sodium ions for potassium ions in the intestines, thereby facilitating the removal of excess potassium from the body through fecal excretion.

The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client? 1. Use the unaffected arm for blood pressure measurements. 2. Draw blood from the cannula for routine laboratory work. 3. Percuss the cannula for bruits each shift. 4. Inject heparin into the cannula each shift.

1. Use the unaffected arm for blood pressure measurements. Rationale: The unaffected arm should be used for blood pressure measurement. The external cannula must be handled carefully and protected from damage and disruption. In addition, a tourniquet or clamps should be kept at the bedside because dislodgment of the cannula would cause arterial hemorrhage. The arm with the cannula is not used for blood pressure measurement, IV therapy, or venipuncture. Patency is assessed by auscultating for bruits every shift. Heparin is not injected into the cannula to maintain patency. Because it is part of the general circulation, the cannula cannot be heparinized.

The nurse is caring for a patient with risk for kidney disease for whom a urinalysis has been ordered. What time would the nurse instruct the unlicensed assistive personnel is BEST to collect this sample? 1. With first morning void 2. Before any meal 3. At bedtime 4. Immediately

1. With first morning void Rationale: Urinalysis is a part of any complete physical examination and is especially useful for patients with suspected kidney or urologic disorders. Ideally, the urine specimen is collected at the morning's first voiding. Specimens obtained at other times may be too dilute.

A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The client's family asks the nurse why the client has developed acute renal failure. What should the nurse tell the family? "Because of the cardiogenic shock, there is: 1. a decrease in the blood flow through the kidneys." 2. an obstruction of urine flow from the kidneys." 3. a blood clot that formed in the kidneys." 4. structural damage to the kidney."

1. a decrease in the blood flow through the kidneys." Rationale: There are three categories of acute renal failure: prerenal, intrarenal, and postrenal. Causes of prerenal failure occur outside the kidney and include poor perfusion and decreased circulating volume, resulting from such factors as trauma, septic shock, impared cardiac function, and dehydration. In this case of severe myocardial infarction, there was a decrease in perfusion of the kidneys caused by impaired cardiac function. An obstruction within the urinary tract, such as from kidney stones, tumors, or benign prostatic hypertrophy, is called postrenal failure. Structural damage to the kidney resulting from acute tubular necrosis is called intrarenal failure. It is caused by such conditions as hypersensitivity (allergic disorders), renal vessel obstruction, and nephrotoxic agents.

The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is MOST appropriate? 1. a gelatin dessert 2. yogurt 3. an orange 4. peanuts

1. a gelatin dessert Rationale: Gelatin desserts contain little to no potassium and can be served to a client on a potassium-restricted diet. Foods high in potassium include bran and whole grains; most dried, raw, and frozen fruits and vegetables; most milk and milk products; and chocolate, nuts, raisins, coconut, and strong brewed coffee.

A client with acute renal failure has a serum potassium level of 6.5 mEq/L. The nurse should monitor the client for which potential complication? 1. cardiac arrest 2. pulmonary edema 3. circulatory collapse 4. hemorrhage

1. cardiac arrest Rationale: Normal potassium levels range from 3.5 to 5.0 mEq/L. Hyperkalemia places the client at risk for serious cardiac arrhythmias. Therefore, the nurse should carefully monitor the client for cardiac arrhythmias and be prepared to treat cardiac arrest when caring for a client with hyperkalemia. Increased potassium levels fo not result do not result in pulmonary edema, circulatory collapse, or hemorrhage.

The client with acute renal failure asks the nurse, "Will my kidneys ever function normally again?" What should the nurse tell the client? "You will: 1. continue to improve over a period of weeks." 2. likely need dialysis." 3. improve when you have a kidney transplant." 4. have more kidney damage in several years."

1. continue to improve over a period of weeks." Rationale: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the health care provider (HCP) if such problems occur. In a client who is recovering from acute renal failure, there is no need for renal transplantation or permanent hemodialysis. Chronic renal failure develops before end-stage renal failure.

The client is in the oliguric phase of acute renal failure. For which risk should the nurse assess the client? 1. pulmonary edema 2. metabolic alkalosis 3. hypotension 4. hypokalemia

1. pulmonary edema Rationale: Pulmonary edema can develop during the oliguric phase of acute renal failure because of decreased urine output and fluid retention. Metabolic acidosis develops because the kidneys cannot excrete hydrogen ions, and bicarbonate is used to buffer the hydrogen. Hypertension may develop as a result of fluid retention. Hyperkalemia develops as the kidneys lose the ability to excrete potassium.

A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? Select all that apply. 1. Remind health care providers to draw blood from veins on the left side. 2. Avoid sleeping on the left arm. 3. Wear wristwatch on the right arm. 4. Assess fingers on the left arm for warmth. 5. Obtain blood pressure (BP) from the left arm.

2, 3, 4 2. Avoid sleeping on the left arm. 3. Wear wristwatch on the right arm. 4. Assess fingers on the left arm for warmth. Rationale: The nurse instructs the client to protect the site of the fistula. The client should avoid pressure on the involved arm such as sleeping on it, wearing tight jewelry, or obtaining BP. The client is also advised to assess the area distal to the fistula for adequate circulation, such as warmth and color. When the client is hospitalized, the nurse posts a sign on the client's bed not to draw or blood or obtain BP on the left side; the client is also instructed to be sure that none of the health care team members do so.

A client with end-stage chronic renal failure is admitted to the hospital with a serum potassium level of 7 mEq/L. In what order of priority from first to last does the nurse perform the prescriptions? All options must be used. 1. Administer insulin and glucose. 2. Start an IV access site. 3. Obtain serum potassium level. 4. Attach the client to a cardiac monitor.

2, 4, 1, 3 2. Start an IV access site. 4. Attach the client to a cardiac monitor. 1. Administer insulin and glucose. 3. Obtain serum potassium level. Rationale: The nurse first assures an IV access site in case the client has respiratory or cardiac arrest. Next, the nurse monitors the client's heart rate and rhythm; cardiovascular signs of elevated serum potassium levels are irregular, slow heart rate; decreased blood pressure; narrow, peaked T waves; widened QRS complexes, prolonged PR intervals, and flattened D waves; frequent ectopy; vascular fibrillation; and ventricular standstill. The nurse then administers intravenous insulin and D50W, which can have an immediate action to antagonize the effect of hyperkalemia on cardiac muscle. Last, the nurse obtains a blood sample to evaluate the effectiveness of the medication.

A client with chronic renal failure who receives hemodialysis twice a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply. 1. Drink fluids before eating solid foods. 2. Have limited amounts of fluid only when thirsty. 3. Limit activity. 4. Keep all dialysis appointments. 5. Eat smaller, more frequent meals.

2, 4, 5 2. Have limited amounts of fluid only when thirsty. 4. Keep all dialysis appointments. 5. Eat smaller, more frequent meals. Rationale: To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty and eat food before drinking fluids to alleviate dry mouth, and encourage strict follow-up for blood work, dialysis, and HCP visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

A patient diagnosed with acute kidney failure had a urine output of 1560 mL for the past 8 hours. The LPN/LVN who is caring for this patient under the RN's supervision asks how a patient with kidney failure can have such a large urine output. What is the RN's BEST response? 1. "The patient's kidney failure was caused by hypovolemia, and we have given him IV fluids to correct the problem." 2. "Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day."

2. "Acute kidney failure patients fo through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day." Rationale: Patients with acute kidney failure usually go through a diuretic phase 2 to 6 weeks after the onset of the oliguric phase. The diuresis can result in an output of up to 10 L/day of dilute urine. During this phase, it is important to monitor for electrolyte and fluid imbalances. This is followed by the recovery phase. A patient with acute kidney failure caused by hypovolemia would receive IV fuids to correct the problem; however, this would not necessarily lead to the onset of diuresis.

The nurse is caring for a patient with renal cell carcinoma (adenocarcinoma of the kidney). While serving as a preceptor for a new nurse orienting to the unit, the nurse is asked why this patient is not receiving chemotherapy. What is the BEST response? 1. "The prognosis for this form of cancer is very poor, and we will be providing only comfort measures." 2. "Nephrectomy is the preferred treatment because chemotherapy has been shown to have only limited effectiveness against this type of cance

2. "Nephrectomy is the preferred treatment because chemotherapy has been shown to have only limited effectiveness against this type of cancer." Rationale: Chemotherapy has limited effectiveness against renal cell carcinoma. This form of cancer is usually treated surgically with nephrectomy.

The nurse is assessing a patient suspected of progressing through the stages of acute renal failure. What sign would indicate to her that the patient is in the second phase of acute renal failure? 1. Urine production is less than 400 mL per day. 2. A daily urine output that doubles, reaching 4 to 5 liters per day. 3. Stabilization of kidney function. 4. A daily urine output of less than 100 mL.

2. A daily urine output that doubles, reaching 4 to 5 liters per day. Rationale: Acute renal failure, also known as acute kidney injury (AKI), typically progresses through three phases: oliguric, diuretic, and recovery. The second phase is the diuretic phase, characterized by a sudden increase in urine output. This occurs as the kidneys start to recover but are not yet fully capable of concentrating urine. As a result, the kidneys excrete a large volume of dilute urine, often reaching 4 to 5 liters per day. This phase can be misleading because, while it may seem like kidney function is returning to normal due to the increased urine output, the kidneys are still effectively filtering waste products from the blood.

Which patient would the charge nurse assign to an RN floated to the acute care unit from the surgical intensive care unit (SICU)? 1. A patient with kidney stone scheduled for lithotripsy this morning 2. A patient who had just undergone surgery for renal stent placement 3. A newly admitted patient with an acute urinary tract infection (UTI) 4. A patient with chronic kidney failure who needs teaching on peritoneal dialysis

2. A patient who had just undergone surgery for renal stent placement Rationale: A nurse from the surgical ICU will be thoroughly familiar and comfortable with the care of patients who have just undergone surgery. The patient scheduled for lithotripsy may need education about the procedure. The newly admitted patient needs an in-depth admission assessment, and the patient with chronic kidney failure needs teaching about peritoneal dialysis. All of these interventions would best be accomplished by an experienced nurse with expertise in the care of patients with kidney problems.

The nurse is caring for a patient with end-stage renal disease who has an arteriovenous fistula in the left arm for hemodialysis. What intervention should be included in the patient's plan of care? 1. Keep the left arm completely dry. 2. Apply consistent pressure to the needle insertion site upon ceasing hemodialysis. 3. Elevate the left arm on an arm board for a minimum of 30 minutes. 4. Maintain the head of the bed at a 45-degree elevation.

2. Apply consistent pressure to the needle insertion site upon ceasing hemodialysis. Rationale: An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, commonly in the arm, to facilitate hemodialysis. One of the primary concerns post-hemodialysis is the risk of bleeding from the needle insertion site. Applying consistent pressure to the site is crucial to promote hemostasis (cessation of bleeding) and prevent complications like hematoma formation or excessive blood loss. Therefore, this intervention should be a priority in the patient's plan of care.

A dialysis nurse is preparing a 54-year-old patient for hemodialysis. The patient has a functioning arteriovenous (AV) fistula in place. What should the nurse prioritize to ensure the patency of the AV fistula before initiating hemodialysis? 1. Apply a warm compress to the AV fistula site. 2. Auscultate the AV fistula for bruit and palpate for thrill. 3. Administer a bolus of saline through the AV fistula. 4. Elevate the extremity with the AV fistula about heart level.

2. Auscultate the AV fistula for bruit and palpate for thrill. Rationale: The nurse should prioritize auscultating the AV fistula for a bruit and palpating for a thrill to ensure its patency before initiating hemodialysis. A functioning AV fistula should have a consistent, swooshing sound (bruit) that is audible with a stethoscope and a buzzing vibration (thrill) this is palpable. These signs indicate that blood is flowing though the fistula as it should, allowing for efficient hemodialysis. If the bruit or thrill is absent, it may mean that the fistula is clotted or not functioning properly, and using it for hemodialysis could be risky.

The nurse is closely monitoring a patient who has been diagnosed with nephritic syndrome. The nurse is eager to identify any positive indicators that would suggest her patient is on the path to recovery. What change would signify that the patient with nephritic syndrome is recovering? 1. Decreased levels of serum albumin 2. Complete absence of protein in the urine 3. Elevated levels of lipids in the blood stream 4. An increase in overall body weight

2. Complete absence of protein in the urine Rationale: Nephritic syndrome is characterized by inflammation of the glomeruli, leading to hematuria, hypertension, and some degree of proteinuria. While proteinuria in nephritic syndrome is generally less severe than in nephrotic syndrome, its complete absence in the urine would be a strong positive indicator of recovery. This suggests that the glomerular filtration barrier has been restored, allowing the kidneys to properly filter blood without losing essential proteins.

The nurse is caring for a 32-year-old patient and is reviewing the patient's medical chart. Based on the symptoms exhibited, what would lead the nurse to suspect the patient may have acute glomerulonephritis? 1. Symptoms of fever, chills, and pain in the right upper quadrant radiating to the back. 2. Elevated blood pressure, reduced urine output, and complaints of fatigue. 3. Complaints of back pain accompanied by nausea and vomiting.

2. Elevated blood pressure, reduced urine output, and complaints of fatigue. Rationale: Acute glomerulonephritis is an inflammatory condition affecting the glomeruli, the tiny filtering units of the kidneys. The hallmark symptoms include elevated blood pressure, reduced urine output (oliguria), and general feelings of fatigue or malaise. These symptoms occur because the inflamed glomeruli are less efficient at filtering waste and excess fluids, leading to fluid retention and increased blood pressure.

The nurse is formulating a care plan for a patient who is end-stage renal disease. Among the various aspects of patient care that is needed to be addressed, what would be the PRIORITY nursing diagnosis for this patient? 1. Nutritional imbalance: insufficient dietary intake 2. Excess fluid volume 3. Elevated risk for physical harm 4. Reduced tolerance for physical activity

2. Excess fluid volume Rationale: For a patient in end-stage renal disease, the priority nursing diagnosis is often "excess fluid volume". The kidneys play a crucial role in fluid balance, and when they are severely compromised, as in ESRD, they can't effectively remove excess fluid from the body. This can lead to a host of problems, including hypertension, edema, and heart failure, making it a critical issue that needs immediate attention.

The nurse is reviewing the medical histories of two different patients: once with renal failure and another with prerenal failure. The nurse aims to differentiate the two conditions based on treatment responsiveness. Which statement accurately distinguishes prerenal failure from renal failure? 1. In prerenal failure, blood urea nitrogen (BUN) levels can be lowered through hemodialysis. 2. In prerenal failure, administering an intravenous infusion of isotonic saline enhances urine production.

2. In prerenal failure, administering an intravenous infusion of isotonic saline enhances urine production. Rationale: Prerenal failure is often caused by reduced blood flow to the kidneys, usually due to dehydration, hypovolemia, or heart failure. The kidneys themselves are not damaged in prerenal failure; they are simply not receiving enough blood to filter properly. Administering an intravenous infusion of isotonic saline can quickly restore blood volume and improve renal perfusion, thereby enhancing urine production and potentially reversing the condition.

While administering peritoneal dialysis to a patient on the dialysis unit, the nurse notes that the return fluid is draining more slowly than usual. What is the nurse's MOST appropriate immediate course of action to address the slow drainage of return fluid during the patient's peritoneal dialysis? 1. Adjust the patient's bed to a reverse Trendelenburg position. 2. Inspect the outflow tubing for any kinks or obstructions. 3. Elevate the drainage bag higher that the patient's abdomen. 4. Request

2. Inspect the outflow tubing for any kinks or obstruction. Rationale: When administering peritoneal dialysis, it's crucial to ensure that the dialysate fluid drains properly. Slow drainage could be due to a variety of factors, but the most immediate and common issue to check and obstruct the flow of fluid, making it difficult for the dialysate to drain from the peritoneal cavity. By inspecting and straightening the tubing, the nurse can quickly resolve the issue without causing any harm to the patient.

Which should be included in the client's plan of care during dialysis therapy? 1. Limit the client's visitors. 2. Monitor the client's blood pressure. 3. Pad the side rails of the bed. 4. Keep the client on nothing-by-mouth (NPO) status.

2. Monitor the client's blood pressure. Rationale: Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.

A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen? 1. Asses for urticaria. 2. Observe respiratory status. 3. Check capillary refill time. 4. Monitor electrolyte status.

2. Observe respiratory status. Rationale: During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the HCP (usually 20 to 45 minutes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during treatment, not just during the dwell time.

The nurse is reviewing the lab values for a patient with risk for urinary problems. Which finding is of MOST concern to the nurse? 1. Blood urea nitrogen (BUN) of 10 mg/mL 2. Presence of glucose and protein in urine 3. Serum creatinine of 0.6 mg/mL 4. Urinary pH of 8

2. Presence of glucose and protein in urine Rationale: When blood glucose levels are greater than 220 mg/dL, some glucose stays in the filtrate and is present in the urine. Normally, almost all glucose and most proteins are reabsorbed and are not present in the urine. Report the presence of glucose or proteins in the urine of a patient undergoing a screening examination to the health care provider because this is an abnormal finding and requires further assessment.

A client with chronic renal failure is receiving hemodialysis three times a week. What should the nurse do to protect the fistula? 1. Take the blood pressure in the arm with the fistula. 2. Report the loss of a thrill or bruit on the arm with the fistula. 3. Maintain a pressure dressing on the shunt. 4. Start a second IV in the arm with the fistula.

2. Report the loss of a thrill or bruit on the arm with the fistula. Rationale: The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the health care provider as it indicated an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as a purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

The nurse is closely monitoring the cardiac status of a patient with end-stage renal disease. The cardiac monitor starts showing frequent PVCs. What is the PRIORITY nursing intervention for this situation? 1. Administer intravenous lidocaine (Xylocaine) to the patient. 2. Review the most recent laboratory results for the patient's potassium level. 3. Ready the equipment for potential defibrillation of the patient. 4. Contact the healthcare provider immediately.

2. Review the most recent laboratory results for the patient's potassium level. Rationale: In a patient with end-stage renal disease (ESRD), frequent PVCs are often a sign of hyperkalemia, or elevated potassium levels. The kidneys are primarily responsible for regulating potassium levels, and in ESRD, this function is compromised. Elevated potassium levels can be have severe cardiac implications, including life-threatening arrhythmias. Therefore, the priority nursing intervention would be to review the most recent laboratory results for the patient's potassium level to confirm or rule out hyperkalemia as the cause of the PVCs.

During dialysis, the client has disequilibrium syndrome. What should the nurse do FIRST? 1. Administer oxygen per nasal cannula. 2. Slow the rate of dialysis. 3. Reassure the client that the symptoms are normal. 4. Place the client in modified Trendelenburg's position.

2. Slow the rate of dialysis. Rationale: If disequilibrium syndrome occurs during dialysis, the most appropriate intervention is to slow the rate of dialysis. The syndrome is believed to result from too-rapid removal of urea and excess electrolytes from the blood; this cause transient cerebral edema, which produces the symptoms. Administration of oxygen and position changes do not affect the symptoms. It would not be appropriate to measure the client that the symptoms are normal.

The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which strategy would be MOST useful? 1. Help the client to accept that sexual activity will be decreased. 2. Suggest using alternative forms of sexual expression and intimacy. 3. Tell the client to plan rest periods after sexual activity. 4. Refer the client to a counselor.

2. Suggest using alternative forms of sexual expression and intimacy. Rationale: Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity. Unless the client provides additional information, it is not necessary to refer the client to counseling at this time.

Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be MOST appropriate? 1. Provide all needed teaching in one extended session. 2. Validate the client's understanding of the material frequently. 3. Conduct a one-on-one session with the client. 4. Use video clips to reinforce the material as needed.

2. Validate the client's understanding of the material frequently. Rationale: Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videotape.

A client is having peritoneal dialysis. During the exchange, the nurse observes that the solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. What clinical judgment should the nurse make about the blood-tinged drainage? 1. It is expected with a permanent peritoneal catheter. 2. It indicates abdominal blood vessel damage. 3. It can indicate kidney damage. 4. It is caused by too-rapid infusion of the dialysate.

2. it indicates abdominal blood vessel damage. Rationale: Because the client has a permanent catheter in place, blood-tinged drainage could indicate damage to the abdominal vessels, and the HCP should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

After completion of peritoneal dialysis, for which symptom should the nurse assess the client? 1. hematuria 2. weight loss 3. hypertension 4. increased urine output

2. weight loss Rationale: Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.

The nurse is caring for a patient who has diabetes mellitus and has recently started hemodialysis due to renal failure. What would be the MOST appropriate dietary recommendation for this patient on the days between dialysis treatments? 1. A low-protein diet with no restrictions on water intake. 2. No dietary restrictions whatsoever. 3. A low-protein diet with a physician-prescribed amount of water intake. 4. A diet devoid of protein, along with the use of a salt substitute.

3. A low-protein diet with a physician-prescribed amount of water intake. Rationale: Patients with diabetes mellitus who are also undergoing hemodialysis due to renal failure have unique dietary needs. A low-protein diet is generally recommended to reduce the workload on the kidneys, which are already compromised. Additionally, water intake should be carefully managed to prevent fluid overload, a common complication in patients undergoing hemodialysis. Since the kidneys are not effectively filtering waste and excess fluids, a physician-prescribed amount of water intake is crucial to maintain fluid balance without overloading the cardiovascular system.

For which patient is the nurse MOST concerned about the risk for developing kidney disease? 1. A 25-year-old patient who developed a urinary tract infection (UTI) during pregnancy 2. A 55-year-old patient with a history of kidney stones 3. A 63-year-old patient with type 2 diabetes 4. A 79-year-old patient with stress urinary incontinence

3. A 63-year-old patient with type 2 diabetes Rationale: A history of chronic health problems, especially diabetes and hypertension, increases the risk for development of kidney disease.

An 18-year-old college student is admitted to the hospital presenting with dark urine, fever, and flank pain. After diagnostic tests, the student is diagnosed with acute glomerulonephritis. What health history factor is most likely to be present in this student's case? 1. Previous renal trauma 2. Family history of acute glomerulonephritis 3. A recent episode of a sore throat 4. History of renal calculi (kidney stones)

3. A recent episode of a sore throat Rationale: Acute glomerulonephritis is often a post-infectious complication, commonly following a streptococcal infection like a sore throat or pharyngitis. The body's immune response to the infection can inadvertently cause inflammation in the glomeruli, the filtering units of the kidneys. This inflammation can lead to symptoms like dark urine, fever, and flank pain. Therefore, a recent episode of a sore throat would be the most likely health history factor in this 18-year-old college student's case.

The nurse is caring for a patient with chronic kidney disease after hemodialysis. Which patient care action should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? 1. Assess the patient's access site for a thrill and bruit. 2. Monitor for signs and symptoms of postdialysis bleeding. 3. Check the patient's postdialysis blood pressure and weight. 4. Instruct the patient to report signs of dialysis disequilibrium syndrome immediately.

3. Check the patient's postdialysis blood pressure and weight. Rationale: Checking vita signs and weighing patients are within the scope of practice for the UAP. However, the nurse must be sure to caution the UAP to check the BP in the arm opposite to the access site. Assessing, teaching, and monitoring require additional skills that fit within the scope of practice for the professional nurse.

The nurse is monitoring a patient who has just completed their first session of hemodialysis. Shortly afterward, the patient starts to experience headache, elevated blood pressure, restlessness, mental confusion, nausea, and vomiting. What condition is MOST likely indicated by these symptoms? 1. Peritonitis 2. Hypervolemia 3. Disequilibrium syndrome 4. Respiratory distress

3. Disequilibrium syndrome Rationale: The symptoms described - headache, elevated blood pressure, restlessness, mental confusion, nausea, and vomiting - are indicative of disequilibrium syndrome. This condition can occur during or after the first few hemodialysis sessions and is caused by a rapid decrease in blood urea nitrogen (BUN) levels. The rapid removal of waste products from the blood can create an osmotic imbalance between the blood and the brain, leading to cerebral edema and the symptoms observed.

The nurse is caring for a patient diagnosed with acute renal failure. He notes that the patient is also experiencing elevated blood pressure levels. The nurse wants to identify the most prevalent cause of hypertension in the context of acute renal failure. What is the most common cause of hypertension in cases of acute renal failure? 1. Low levels of red blood cells 2. Fluid accumulation in the lungs 3. Excessive fluid volume in the body 4. Insufficient fluid volume in the body

3. Excessive fluid volume in the body Rationale: In the context of acute renal failure, the most common cause of hypertension (elevated blood pressure) is excessive fluid volume in the body. The kidneys play a crucial role in regulating fluid balance by filtering excess fluid and waste products from the blood. When the kidneys fail to function properly, they are unable to excrete excess fluid, leading to fluid overload and subsequently elevated blood pressure.

The nurse is responsible for a patient who recently had an arteriovenous fistula placed for hemodialysis. She know's it's crucial to regularly assess for patency. What is the best method for the nurse to check the patency of this arteriovenous fistula? 1. Aspirate blood from the fistula using a needle and syringe. 2. Compress the fistula and observe the rate of refilling upon release. 3. Palpate along the entire length of the fistula for the presence of a thrill. 4. Evaluate capillary refill time.

3. Palpate along the entire length of the fistula for the presence of a thrill. Rationale: The best method to assess the patency of an arteriovenous (AV) fistula is by palpating along its entire length for the presence of a thrill, which is a continuous, low-frequency vibration felt over the fistula. The thrill is a good indicator that blood is flowing adequately through the fistula, which is essential for successful hemodialysis. A lack of thrill could indicate a problem such as clot formation or stenosis, which would require immediate medical attention.

The nurse is conducting an educational session on the early signs of kidney disease for a group of nursing students. She poses the following question: What is the MOST frequently observed early sign of kidney disease? 1. Excessive thirst and hunger 2. Blood in the urine 3. Proteinuria 4. Elevated blood pressure

3. Proteinuria Rationale: Proteinuria, or the presence of an abnormal amount f protein in the urine, is often one of the earliest signs of kidney disease. Normally, the kidneys filter out waste while retaining essential elements like proteins. When the kidneys are damaged, their filtering capability is compromised, allowing proteins to leak into the urine. Proteinuria is often detected through routine urine tests and can be a red flag for various kidney diseases, including chronic kidney disease and glomerulonephritis.

The nurse is caring for a patient who has been recently diagnosed with acute glomerulonephritis. Based on the diagnosis, what clinical manifestations would the nurse expect to see in the patient? 1. Painful urination and low blood pressure 2. Increased thirst and frequent urination 3. Reduced urine output and generalized swelling 4. Chills and pain in the area between the rib and hip

3. Reduced urine output and generalized swelling Rationale: Acute glomerulonephritis is an inflammatory condition affecting the glomeruli, the kidney's filtering units. One of the primary manifestations of this condition is reduced urine output, also known as oliguria. This happens because the inflamed glomeruli are less efficient at filtering waste and excess fluid from the blood. Another common symptom is generalized swelling or edema, particularly in the face, hands, and feet. This occurs because the kidneys are not effectively removing excess fluid form the body, leading to fluid retention.

Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of this drug? 1. relieving the pain of gastric hyperacidity 2. preventing Curling's stress ulcers 3. binding phosphate in the intestine 4. reversing metabolic acidosis

3. binding phosphate in the intestine Rationale: A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.

Which abnormal blood value would not be improved by dialysis treatment> 1. elevated serum creatinine level 2. hyperkalemia 3. decreased hemoglobin concentration 4. hypernatremia

3. decreased hemoglobin concentration Rationale: Dialysis has no effect on hemoglobin levels because some red blood cells are injured during the procedure; dialysis aggravates a low hemoglobin concentration and may contribute to anemia. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances such as creatinine, potassium, and sodium levels.

The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be MOST appropriate? 1. high-carbohydrate, high-protein 2. high-calcium, high-potassium, high-protein 3. low-protein, low-sodium, low-potassium 4. low-protein, high-potassium

3. low-protein, low-sodium, low-potassium Rationale: Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the by-products of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching? 1. "I'll take it every 4 hours around the clock." 2. "I'll take it between meals and at bedtime." 3. "I'll take it when I have an upset stomach." 4. "I'll take it with meals and bedtime snacks."

4. "I'll take it with meals and bedtime snacks." Rationale: Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.

The nurse is caring for a patient admitted with dehydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this diagnosis? 1. 1.010 2. 1.035 3. 1.020 4. 1.002

4. 1.002 Rationale: A patient with dehydration due to deficient ADH would have diluted urine with a decreased urine specific gravity. Normal urine specific gravity ranges from 1.003 to 1.030. A specific gravity of 1.035 would indicate urine that is concentrated.

The patient problem of constipation related to compression of the intestinal tract has been identified in a patient with polycystic kidney disease. Which care action should the nurse assign to the newly-trained LPN/LVN? 1. Instructing the patient about foods that are high in fiber 2. Teaching the patient about foods that assist in promoting bowel regularity 3. Assessing the patient for previous bowel problems and bowel routine 4. Administering docusate sodium 100 mg by mouth twice a day

4. Administering docusate sodium 100 mg by mouth twice a day Rationale: Administering oral medications appropriately is covered in the educational program for LPNs/LVNs and is within their scope of practice. Teaching and assessing the patient require additional education and skill and are appropriate to the scope of practice of RNs.

The nurse is monitoring a postoperative patient who has been back from surgery for six hours. The patient has an indwelling catheter, which was empty upon return but now shows only 120 mL of urine. The nurse confirms that the drainage system is not obstructed. What is the nurse's PRIORITY intervention in this situation? 1. Irrigate the urinary catheter with sterile saline or water. 2. Position the patient for shock management and alert the surgical team. 3. Administer a 500 mL bolus of isotonic 4. Assess the patient's circulatory status and vital signs.

4. Assess the patient's circulatory status and vital signs. Rationale: In a postoperative setting, a low urine output like 120 mL over six hours is concerning and could indicate renal perfusion or the onset of acute kidney injury. The priority intervention is to assess the patient's circulatory status and vital signs. This will provide valuable information about the patient's overall hemodynamic stability and could offer clues as to why the urine output is low.

The nurse is overseeing the hemodialysis treatment of patient when he notices she starts to become agitates. She complains of a headache and mentions feeling nauseous. The nurse need to identify the likely complication that could be manifesting. What complication should the nurse suspect based on the patient's symptoms during hemodialysis? 1. Acute hemolysis 2. Bacterial or viral infection 3. Entrapment of air in the bloodstream 4. Disequilibrium syndrome

4. Disequilibrium syndrome Rationale: Disequilibrium syndrome is a neurological complication that can occur during hemodialysis, particularly in patients who are new to the treatment or those who have had significant change in their dialysis prescription. The symptoms include headache, nausea, restlessness, and in severe cases, seizures or coma. The syndrome is thought to occur due to a rapid decrease in blood urea levels during dialysis, which creates an osmotic imbalance between the blood and the brain. This imbalance can lead to cerebral edema, or swelling of the brain tissue, manifesting as the symptoms the patient is experiencing.

During a session of hemodialysis, the nurse notices that her patient starts to complain about experiencing muscle cramps. What should the nurse do immediately to effectively relieve the patient's muscle cramps? 1. Urge the patient to perform active range-of-motion exercises. 2. Accelerate the rate of ongoing hemodialysis treatment. 3. Administer a 5% dextrose solution Intravenously. 4. Infuse a normal saline solution intravenously.

4. Infuse a normal saline solution intravenously. Rationale: Muscle cramps during hemodialysis are a common but distressing complication. They are often caused by the rapid removal of fluid from the body, leading to hypovolemia and electrolyte imbalances. Infusing a normal saline solution intravenously can help to restore the fluid balance and alleviate the cramps. Normal saline is isotonic, meaning it has the same concentration of solutes as the body's cells, making it an ideal choice for quickly restoring intravascular volume without causing further imbalances.

The nurse is caring for a patient who recently underwent surgery to create an arteriovenous fistula for hemodialysis. What key information should the nurse keep in mind when providing care for this patient? 1. Auscultating the fistula with a stethoscope is not advised. 2. The patient should not experience pain during the initiation of dialysis. 3. The patient generally feels at their best immediately following dialysis treatment. 4. Measuring blood pressure on the arm with the arteriovenous fistula can lead to clot formation.

4. Measuring blood pressure on the arm with the arteriovenous fistula can lead to clot formation. Rationale: An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein to facilitate hemodialysis. It's crucial to avoid any form of pressure or constriction on the arm with the AV fistula, as this can lead to clot formation, which would compromise the fistula's function. Measuring blood pressure on the arm with the AV fistula can exert pressure on the blood vessels, increasing the risk of clot formation and potentially lead to fistula failure.

The nurse has delegated collection of a urinalysis specimen to an experienced unlicensed assistive personnel (UAP). For which action must the nurse intervene? 1. The UAP provides the patient with a specimen cup. 2. The UAP reminds the patient of the need for the specimen. 3. The UAP assists the patient to the bathroom. 4. The UAP allows the specimen to sit for more than 1 hour.

4. The UAP allows the specimen to sit for more than 1 hour. Rationale: Urine specimens become more alkaline when left standing unrefrigerated more than 1 hours, when bacteria are present, or when a specimen is left uncovered. Alkaline urine increases cell breakdown; thus, the presence of red blood cells may be missed on analysis. Ensure that urine specimens are covered and delivered to the laboratory promptly or refrigerated. Actions 1, 2, and 3 are appropriate for urinalysis specimen collection.

A client is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure? 1. Assess the dialysis access for a bruit and thrill. 2. Insert an indwelling catheter and drain all urine from the bladder. 3. Ask the client to turn toward the left side. 4. Warm the dialysis solution in the warmer.

4. Warm the dialysis solution in the warmer. Rationale: Solution for peritoneal dialysis should be warmed to body temperature in a warmer or with a heating pad; do not use the microwave. Cold dialysate increases discomfort. Assessment for a bruit and thrill is necessary with hemodialysis when the client has a fistula, graft, or shunt. An indwelling urinary catheter is not required for this procedure. The nurse should position the client in a supine or low Fowler's position.

A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, what should the nurse the client about experiencing recently? 1. diarrhea 2. vomiting 3. flatulence 4. constipation

4. constipation Rationale: Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. What should the nurse tell the client to expect when following this diet? The diet will: 1. act as a diuretic. 2. reduce demands on the liver. 3. help maintain urine acidity. 4. prevent the development of ketosis.

4. prevent the development of ketosis. Rationale: High-carbohydrate foods meet the body's caloric needs during acute renal failure. Protein is limited because its breakdown may result in accumulation of toxic waste products. The main goal of nutritional therapy in acute renal failure is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phosphate, and potassium. Carbohydrates provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbohydrates influence urine pH, but this is not the reason for encouraging a high-carbohydrate, low-protein diet. There is no need to reduce demands on the liver through dietary manipulation in acute renal failure.

The nurse is teaching the client how to recognize infection in the shunt. What sign should the nurse tell the client to assess each day? 1. absence of a bruit 2. sluggish capillary refill time 3. coolness of the involved extremity 4. swelling at the shunt site

4. swelling at the shunt site Rationale: Signs and symptoms of an external access shunt infection include redness, tenderness, swelling, and drainage from around the shunt site. The absence of a bruit indicated closing of the shunt. Sluggish capillary refill time and coolness of the extremity indicate decreased blood flow to the extremity.